搜索结果：Asian journal of urology

The diagnostic efficacy of hybrid positron emission tomography (PET)/MRI in detecting primary prostate cancer (PCa) is limited due to the lack of a quantitative integrated analysis. A new Prostate Imaging Reporting and Data System (PI-RADS) incorporating prostate-specific membrane antigen (PSMA) PET for PET/MRI has been introduced to improve primary detection of PCa. One hundred and twenty consecutive patients with high clinical suspicion of PCa were enrolled in this prospective study to assess the diagnostic performance of PSMA-adjusted PI-RADS (PAPI-RADS) using 68Ga-PSMA-11 PET/MRI. Tumor PSMA uptake was assessed semi-quantitatively using the maximum and peak standardized uptake values. The PAPI-RADS was obtained by combining tumor PSMA uptake with PI-RADS. Patients were divided into two groups: a training group (90 patients) and a validation group (30 patients). The cutoff value of PSMA intensity was determined via receiver operating characteristic analysis. PAPI-RADS was then applied to the validation group. Histopathology was used as the gold standard to verify the diagnostic efficacy. In the training group, PAPI-RADS detected more cases of PCa than PI-RADS. PAPI-RADS had a sensitivity of 99%, specificity of 100%, negative predictive value of 92%, and overall accuracy of 99%. PI-RADS had a sensitivity of 94%, specificity of 75%, negative predictive value of 64%, and overall accuracy of 90%. PAPI-RADS was significantly better than PI-RADS in detecting PCa (&#x3c7; 2 =6.57, p=0.010). The external validation of this study confirmed the diagnostic efficacy of PAPI-RADS in PCa patients. PAPI-RADS is significantly better than PI-RADS in detecting PCa. PAPI-RADS can improve the diagnostic accuracy of PCa detection, especially in patients with a PI-RADS score <3 lesions. PAPI-RADS can improve the accuracy of PCa diagnosis and avoid unnecessary biopsies.

While technical operating skills and clinical knowledge are often the goals of surgical training, for overall competency, the required skill set goes far beyond these. Social and cognitive abilities in the form of non-technical skills (NTS) are indispensable competencies that complement a surgeon's procedural efficiency and contribute towards patient safety. The NTS are classified into three unique groups: cognitive (decision-making and situational awareness), social (leadership, teamwork, and communication), and personal resource factors (an individual's ability to manage fatigue and stress). Inadequacy in the aforementioned is often the underlying cause of detrimental operating room outcomes and surgical errors universally. This review looks at various components of NTS and evaluation tools currently in use, their importance in urological training, and the need to introduce a formal programme. This would not only complement technical skills, but also serve as an integral and mandatory part of training years for all grades of urologists. Assessment of NTS through comprehensively validated rating tools allows for the evaluation of skills and therefore finds room for improvement in competencies. Commonly used systems include the Non-Technical Skills for Surgeons (NOTSS), Non-Technical Skills (NOTECHS), and Observational Teamwork Assessment for Surgery (OTAS). The significance of associating team culture with the safety of surgery is increasingly recognised, given that human error is unavoidable and hard to eradicate. Whilst we now have a clear definition of the NTS and their importance in surgery and the operating theatre, there is still a lack of a validated and standardised NTS training programme directed at urologists, and that is applicable to all levels, whether they be trainees or consultants. Simulation-based learning is an excellent avenue for progressing surgical education and should be taken advantage of in developing a curriculum that is mandatory for NTS training in urology.

Low-risk prostate cancer usually has an indolent course, and in this scenario, active surveillance (AS) is currently the preferred management, reducing overtreatment without compromising oncologic outcomes in well-selected patients. Two pillars of this strategy are patient selection and adequate monitoring strategy to detect early progression, leading to active treatment in the window of curability. The aim of this review is to assess the novel available tools and their role in AS. We conducted a comprehensive review of the current literature addressing the risk of reclassification and studies evaluating traditional and emerging diagnostic and prognostic tools, including imaging modalities, biomarkers, and genomic classifiers, which could decrease reclassification rates and minimize the burden of serial exams during follow-up and, especially, the frequency of biopsies, which are still necessary to evaluate progression. The most significant follow-up cohorts demonstrate long-term treatment rates ranging from 30% to 45%, and 36% of low-risk prostate cancer patients have an upgrade in radical prostatectomy specimens. Despite the emergence of new diagnostic and prognostic tools, few of them have been validated or included in the assessment of eligible patients for AS. In the current guidelines, a combination of cT stage, Gleason score, prostate-specific antigen value, prostate-specific antigen density, and number of positive cores in biopsy is used to select patients for AS. However, various risk factors have been associated with the risk of reclassification, which reveals the need to incorporate better tools that may contribute to better risk stratification of patients eligible for AS. Although AS is feasible and safe, the risk of progression is of great concern for patients and physicians, and monitoring is also an important part of the therapeutic strategy. Novel risk stratification tools are promising but need further validation to improve results and decrease the burden and anxiety that monitoring can bring to patients.

In patients with metastatic hormone-sensitive prostate cancer (mHSPC), darolutamide significantly improved radiological progression-free survival versus placebo (hazard ratio [HR] 0&#xb7;54, 95% CI 0&#xb7;41-0&#xb7;71) in the phase 3 ARANOTE study. In addition to survival, symptom control and health-related quality of life (HRQoL) are important factors in treatment decision making; we therefore report pain, HRQoL, and safety outcomes from the ARANOTE trial. ARANOTE is an international, randomised, double-blind, placebo-controlled, phase 3 trial involving men aged 18 years or older, with Eastern Cooperative Oncology Group performance status 0-2 and recurrent or de novo mHSPC, treated at 133 cancer centres in 15 countries. Participants were randomly assigned (2:1) to 600 mg darolutamide or matching placebo orally twice daily, both with investigator's choice of androgen deprivation therapy (ADT; luteinising hormone-releasing hormone agonist or antagonist, or orchiectomy) starting within 12 weeks before randomisation. Randomisation was stratified by presence versus absence of visceral metastases and by previous versus no previous local therapy. Treatment was assigned centrally using an interactive web response system based on a computer-generated permuted block randomisation list with block sizes of six. The investigators, the participants, and the sponsor remained masked to treatment assignment throughout the study. The primary endpoint (reported previously) was radiological progression-free survival. Here, we assessed time to pain progression (&#x2265;2-point increase in Brief Pain Inventory-Short Form worst pain score or initiation of opioid for &#x2265;7 days; secondary endpoint) and time to deterioration of overall wellbeing (&#x2265;10-point decrease in Functional Assessment of Cancer Therapy-Prostate [FACT-P] total score; prespecified exploratory endpoint). Pain and HRQoL outcomes were analysed in the intention to treat population; safety was analysed in all treated patients according to treatment actually received. The trial, registered at ClinicalTrials.gov, NCT04736199, is ongoing, but no longer recruiting. Between Feb 23, 2021, and June 14, 2022, 669 patients (all male; 376 [56%] White, 209 [31%] Asian, 65 [10%] Black, 19 [3%] other race) were randomly assigned to receive darolutamide (n=446) or placebo (n=223). At the data cutoff date for the primary analysis (June 7, 2024), the median follow-up duration for the analyses presented here was 22&#xb7;8 months (IQR 12&#xb7;3-27&#xb7;4) in the darolutamide group and 20&#xb7;3 months (11&#xb7;4-25&#xb7;2) in the placebo group. Darolutamide delayed time to pain progression (HR 0&#xb7;72; 95% CI 0&#xb7;54-0&#xb7;96) and extended time to deterioration in FACT-P total score (HR 0&#xb7;76; 0&#xb7;61-0&#xb7;94) versus placebo. The most common grade 3-4 adverse events were hypertension (19 [4%] of 445 patients who received darolutamide vs eight [4%] of 221 patients who received placebo), anaemia (14 [3%] vs eight [4%]), and aspartate aminotransferase increase (ten [2%] vs one [<1%]). Serious adverse events occurred in 105 (24%) versus 52 (24%) patients, respectively. One treatment-related grade 5 event occurred, reported as death (not otherwise specified). Along with the known survival benefits, the clinically meaningful delays in pain progression and time to deterioration of overall wellbeing support consideration of darolutamide plus ADT as a standard-of-care treatment option in patients with mHSPC. Bayer and Orion Pharma.

Robotic surgical systems have revolutionized minimally invasive procedures, offering enhanced three-dimensional visualization, high precision, and stable operation, particularly beneficial for radical prostatectomy. However, high costs have hindered the adoption of robot-assisted radical prostatectomy (RARP) in grassroots hospitals in China. This retrospective study aimed to evaluate the efficacy and safety of the EDGE Surgical Robotic System in performing RARP. A total of 129 patients who underwent RARP at our center between November 2023 and March 2025 were analyzed, with outcomes assessed including port placement to docking time, operative time, estimated blood loss, complications, pathological results, safety indicators, length of hospital stay, catheterization duration, postoperative PSA level, and early urinary continence recovery rate. All surgeries were completed successfully without conversion to laparoscopic or open procedures, with a mean setup time of 36.9&#xa0;min, operative time of 176.3&#xa0;min, and estimated blood loss of 128.1 mL. The positive surgical margin (PSM) rate was documented at 31.0%, with an average hospital stay of seven days and catheterization duration of 15.4 days. Importantly, no safety incidents were reported, and the average total cost of hospitalization and operative cost was CNY &#xa5;59854.8 (USD $8287.8) and &#xa5;36,249.2 (USD $5,019.26), respectively, indicating a cost-effective approach. While the study's retrospective design is a limitation, the findings provide preliminary evidence that the EDGE Surgical Robotic System is a safe and economically viable alternative for RARP, paving the way for broader implementation in similar healthcare settings.

Second primary malignancy (SPM) is becoming a challenge in clinical practice. However, limited studies have focused on this issue in patients with prostate cancer (PCa). We sought to explore the potential risk of SPMs in patients with a prior diagnosis of PCa and construct a model to predict the risk of developing SPMs. We retrospectively extracted data on PCa patients from the Surveillance, Epidemiology, and End Results database between 2000 and 2018. A competing-risk model was established to explore the risk factors for developing SPMs and to predict the probability of developing SPMs for PCa patients after the initial diagnosis. The calibration curve, concordance index, and decision curve analysis were used to assess the validity of the model. A total of 284 738 eligible PCa patients were included, 14 845 (5.2%) of whom developed SPMs after the initial diagnosis. The results showed that age at the initial diagnosis, race, histological grade, pathological tumor stage, radiotherapy, and surgery were independent risk factors for developing SPMs. The concordance index of the model was 0.685 (95% confidence interval 0.684-0.686), and the calibration plots showed an excellent agreement between the nomogram prediction and the actual observation. Furthermore, the decision curve analysis indicated a positive benefit with the threshold risk range of 2%-12%. The nomogram is sufficiently accurate to predict the risk of SPMs for PCa survivors and to help surgeons identify patients who are at a high risk of developing SPMs and contribute to further management of SPMs.

The primary objective of this study was to evaluate the radiological outcomes of robot-assisted ureteric reimplantation. The secondary objectives were to assess the demographics of patients, aetiology of ureteric pathology, length of stay, presence of postoperative lower urinary tract symptoms, and complication rates and to compare these outcomes with those in the current literature. A retrospective multi-centre cohort study was conducted, including all patients undergoing robot-assisted ureteric reimplantation for various indications. Demographic data were collected as well as the aetiology of ureteric pathology, type of surgery, length of stay, and any postoperative complications (Clavien-Dindo grade). The radiological and functional outcomes were also collected. Thirty-four cases that underwent robot-assisted ureteric reimplantation were reviewed. The mean age was 55 years. Psoas hitch and Boari flap were performed in 20 and eight cases, respectively. The mean length of stay was 5.7 days. The radiological resolution was achieved in 94% of cases. Major complications, defined as Clavien-Dindo grade III or above, occurred in four (12%) cases. Robot-assisted ureteric reimplantation, while relatively novel, has proven to be a viable alternative to traditional open surgery.

This study aimed to evaluate the diagnostic accuracy of MRI in the detection of nodal metastasis in urothelial bladder cancer (UBC) and to assess the long-term oncological outcomes of upfront radical cystectomy (RC) in patients with clinical lymph node-positive (cN+) muscle-invasive UBC. A retrospective analysis of 1053 consecutive UBC patients treated with RC between January 1, 2004 and January 31, 2014 was performed. Radiological, clinical, pathological data and survival outcomes of cN+ patients were collected. Cox regression analyses were used to assess the impact of the radiological, clinical, and pathological variables on survival. A total of 233 (22%) patients were diagnosed with cN+ UBC with a mean age of 57.3 (standard deviation 8.1) years, of whom 144 (62%) were found to have pathologically positive lymph nodes at final pathology. Adjuvant chemotherapy was administered to 58 (25%) patients. The sensitivity, specificity, positive predictive value, and negative predictive value of MRI to detect pathological lymph node-positive disease were 51%, 88%, 62%, and 83%, respectively. The overall accuracy was 79% with a calculated area under the curve of 70%. The median follow-up period was 17.0 (interquartile range 8.2-58.7) months. During this period, 54 (23%) patients developed local recurrence while 56 (24%) experienced distant metastasis and the estimated 1-, 3-, 5-, and 10-year recurrence-free survival for cN+ patients were 78%, 56%, 51%, and 48%, respectively. On multivariate analysis, advanced pT stage (pT3-4 vs. pT2) was the only independent predictor of recurrence-free survival. Despite its potential in preoperative assessment of muscle-invasive UBC, MRI showed limited sensitivity for detecting node-positive disease. Notably, in patients with MRI-detected cN+ UBC, those who underwent upfront RC demonstrated long-term survival outcomes comparable to those treated with neoadjuvant chemotherapy followed by consolidative cystectomy in previously published studies.

Chronic respiratory diseases are an important global issue, particularly in Asia, where burden patterns vary widely across countries. With more than half the world's population living in Asia, understanding the national and regional burden of chronic respiratory diseases is essential; however, research on this area remains inadequate. We aimed to investigate the burden of chronic respiratory diseases in Asia at national and regional levels, and to identify key risk factors. The Global Burden of Diseases, Injuries, and Risk Factors Study 2023 provides estimates for assessing the burden of chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease (ILD), and pulmonary sarcoidosis. We focused on 34 countries in Asia, encompassing the high-income Asia Pacific region and central, east, south, and southeast Asia. Estimates for age-standardised prevalence and disability-adjusted life-year (DALY) rates per 100&#x2009;000 population, including 95% uncertainty intervals (UIs), were extracted by location, sex, year, and Socio-demographic Index (SDI). The average annual percentage change was calculated and presented as a percentage with 95% CIs. Estimates of modifiable attributable risk factors for DALYs and mortality were also included. In Asia, the age-standardised prevalence and DALY rates for chronic respiratory diseases generally declined from 1990 to 2023; however, the trend varied substantially by disease and country. In 2023, the age-standardised prevalence rate of COPD was highest in south Asia (3044&#xb7;18 [95% UI 2748&#xb7;67-3303&#xb7;04] per 100&#x2009;000 population), while the age-standardised asthma prevalence rate was highest in the high-income Asia Pacific region (4870&#xb7;24 [4046&#xb7;70-5962&#xb7;78] per 100&#x2009;000 population) and southeast Asia (4778&#xb7;18 [3970&#xb7;25-5735&#xb7;61] per 100&#x2009;000 population). Despite southeast Asia and the high-income Asia Pacific region having a similar age-standardised asthma prevalence rate, southeast Asia had a higher age-standardised DALY rate (508&#xb7;67 [95% UI 394&#xb7;89-669&#xb7;92] per 100&#x2009;000 population) compared with the high-income Asia Pacific region (204&#xb7;40 [129&#xb7;23-290&#xb7;41] per 100&#x2009;000 population). A decrease in the age-standardised DALY rate for chronic respiratory diseases was observed with increasing SDI, contrasting with its prevalence patterns. Age-standardised DALY rates of COPD decreased in all Asian countries except for Georgia (average annual percentage change 1&#xb7;37 [95% CI 1&#xb7;26-1&#xb7;48]) and Kazakhstan (0&#xb7;73 [0&#xb7;55-0&#xb7;93]), and age-standardised DALY rates of asthma decreased in all countries. Smoking and ambient particulate matter pollution were identified as leading attributable risk factors for chronic respiratory diseases across Asia. Household air pollution from solid fuels was a regionally pronounced risk factor for chronic respiratory diseases, particularly in south Asia (age-standardised DALY rate 657&#xb7;58 [95% UI 485&#xb7;04-880&#xb7;45] per 100&#x2009;000 population). Although smoking was a major risk factor in males, ambient particulate matter pollution and secondhand smoke emerged as important attributable risk factors for chronic respiratory diseases in females. Countries with lower SDI had markedly higher DALY rates, highlighting the need to address socioeconomic and health-care inequities. Household air pollution from solid fuels continues to impose a substantial but preventable burden in south Asia, calling for clean energy adoption and improved ventilation. Gates Foundation.

Overactive bladder (OAB) is a common clinical manifestation of voiding dysfunction. It is a symptom-based condition. A new, accurate, objective, and noninvasive test to diagnose OAB and assess therapeutic outcomes is lacking. The study aimed to assess the use of the urinary biomarker brain-derived neurotrophic factor (BDNF), as a non-invasive diagnostic and follow-up tool. This prospective analytical study was conducted in the Department of Urology, Cairo University Hospitals. A total of 96 women were included in the study and distributed into two groups: Group A with OAB (n=48) and Group B (control group, n=48). The mean urinary BDNF/creatinine ratio in the OAB group was 15.2 (standard deviation [SD] 5.9) pg/mg, ranging from 5.1 to 24.2 pg/mg, whereas the mean urinary BDNF/creatinine ratio in the control group was 5.6 (SD 2.7) pg/mg, ranging from 1.1 to 10.0 pg/mg, with a statistically significant difference between the groups (independent samples t-test, p<0.001). Following a 3-month treatment period with solifenacin, a statistically significant reduction was found in the urinary BDNF/creatinine ratio of the OAB group to a mean of 8.2 (SD 3.7) pg/mg, ranging from 2.2 to 14.7 pg/mg (paired samples t-test, p<0.001). BDNF can be used to assess the presence of OAB and follow up the course of OAB as a supplementary tool to clinical assessment and urodynamics.

Meningitis remains the leading infectious cause of neurological disabilities globally, disproportionately affecting children younger than 5 years and populations in the African meningitis belt. Whereas previous global estimates focused on ten pathogen categories, this study presents the most comprehensive analysis to date, assessing the meningitis burden attributable to 17 causative pathogens based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework. GBD is a systematic, scientific effort aimed at quantifying the comparative magnitude of health loss caused by diseases, injuries, and risk factors across age groups, sexes, and geographical locations over time. We estimated meningitis mortality using the Cause of Death Ensemble model (CODEm) and morbidity using DisMod-MR 2.1, incorporating data from vital registration, verbal autopsy, surveillance, hospital data, and systematic reviews. Aetiology-specific estimates were generated with pathogen-linked case-fatality ratios and splined binomial regression models. Risk factor attribution was based on established risk-outcome pairs and population attributable fractions. In 2023, there were 259&#x2009;000 (95% uncertainty interval 202&#x2009;000-335&#x2009;000) global deaths and 2&#xb7;54 million (2&#xb7;20-2&#xb7;93) incident cases of meningitis. Children younger than 5 years accounted for more than a third of deaths (86&#x2009;600 [53&#x2009;300-149&#x2009;000]). Streptococcus pneumoniae, Neisseria meningitidis, non-polio enteroviruses, and other viruses were the leading causes of death, while non-polio enteroviruses caused the most cases. The four WHO-defined preventable meningitis pathogens of interest (S pneumoniae, N meningitidis, Haemophilus influenzae, and Group B streptococcus) contributed to 98&#x2009;700 deaths (77&#x2009;000-127&#x2009;000) and 594&#x2009;000 cases (514&#x2009;000-686&#x2009;000). Low birthweight, short gestation, and household air pollution were the top risk factors for meningitis-related mortality. Although mortality and incidence have declined significantly since 1990, progress is insufficient to meet WHO 2030 targets. Despite marked progress in reducing bacterial meningitis via global vaccination campaigns, a substantial meningitis burden persists, attributable both to common pathogens such as S pneumoniae and N meningitidis and to emerging non-bacterial pathogens such as Candida spp and drug-resistant fungi. Achieving WHO goals will require sustained investment in surveillance, vaccination, maternal screening, and health-system strengthening, especially in high-burden settings. Gates Foundation, Wellcome Trust, and UK Department of Health and Social Care.

To assess the prevalence of low serum testosterone in men undergoing urologic surgery and the associations between low testosterone, frailty, and postoperative outcomes. A prospective study of adult men undergoing urologic surgery between October 2022 and October 2024 was conducted. Morning serum testosterone levels were measured, and baseline sociodemographic characteristics and comorbid medical conditions were collected. The clinical Risk Analysis Index for measuring frailty in surgical populations was calculated. Postoperative outcomes were assessed up to 90 days after surgery. We enrolled 125 patients with a mean age of 64.4 years and a median body mass index of 28.1 (interquartile range 25.6-31.8) kg/m2. The median total testosterone of all patients was 305 (interquartile range 252-361) ng/dL. There were 56 (45%) men who had a testosterone level <300 ng/dL. Men with hypertension and obesity were significantly more likely to have low testosterone; for hypertension, the odds ratio (OR) was 2.30 (p<0.001); for obesity, the OR was 5.64 (p<0.001); and for men with both obesity and hypertension, the OR was 12.97 (p=0.043). There was no significant difference in median clinical Risk Analysis Index score between men with low testosterone and men with normal testosterone (36.0 vs. 36.0, p=0.8). There was no association between low testosterone and postoperative readmissions within 90 days. Our study of patients undergoing urologic surgery found a high prevalence of low testosterone (45%). Urologists should consider evaluating all surgical patients for symptomatic hypogonadism. Further research on the postoperative implications of low testosterone and on the role of testosterone replacement therapy in the perioperative setting is needed.

This study aimed to investigate the anatomy of the accessory pudendal artery (APA) in Asian men and to describe APA preservation techniques during robot-assisted radical prostatectomy (RARP). APA was defined as "any artery located in the periprostatic region running parallel to the dorsal vascular complex and extending caudally toward the anterior perineum". The anatomical variations of the APA were reviewed in 589 consecutive Japanese men who underwent conventional RARP at our institution between April 2019 and November 2023, including the number, laterality, side, size, and local distribution (apical vs. lateral). The apical APA emerges near the prostatic apical region, whereas the lateral APA courses along the lateral aspect of the prostate. They are further classified as the prostatic, fascial, and pubic APAs. Our APA identification and preservation techniques were described based on this classification. Of the 589 Japanese men, 299 (51%) men were with one or more APAs: 169 with one APA, 115 with two APAs, 14 with three APAs, and one with four APAs; and a total of 445 APAs were found. Approximately 97% of the APAs (432/445) were preserved. More lateral APAs were found than apical APAs (243/589 [41%] vs. 79/589 [13%]; p<0.001). Lateral APAs had a higher proportion of large-caliber arteries than apical APAs (59/359 [16%] vs. 1/86 [1.2%]; p<0.001), particularly prostatic and fascial APAs (14/59 [24%] and 40/163 [25%], respectively). This study identified anatomical variations of APAs in Japanese men and demonstrated that nearly all could be preserved during RARP. Further research is needed to evaluate the clinical benefits of APA preservation.

This study aims to evaluate the global burden of adverse effects of medical treatment (AEMT) using data from the Global Burden of Disease Study (GBD) 2021. Data were extracted from the GBD 2021, covering 204 countries/territories from 1990 to 2021. AEMT was defined using ICD-9 and ICD-10 codes, encompassing complications from medical procedures, treatments, or healthcare exposures. Estimates were categorized into fatal and non-fatal outcomes and stratified by age, sex, year, and covariates, including the Socio-demographic Index (SDI). Mortality-incidence ratios (MIRs), defined as the ratio of mortality calculated by dividing the number of deaths by the total incident cases, were analyzed. In 2021, the global age-standardized prevalence, incidence, disability-adjusted life years (DALYs), and mortality rates of AEMT were 11.48 (95% uncertainty interval [UI], 8.86-14.13), 150.44 (131.19-171.81), 64.19 (51.06-73.11), and 1.53 (1.29-1.68) per 100,000 population, respectively. DALY rates were highest in the early neonatal group (4,789.47 per 100,000 population [95% UI, 3,682.00-5,963.30]), while mortality rates followed a U-shaped pattern across age groups. In 2021, MIRs were highest at both ends of the age range: the early neonatal group (0.58 [95% UI, 0.55-0.58]) and the 95+ age group (0.05 [0.04-0.06]). This pattern was consistent across all SDI quintiles, with higher MIRs observed in lower SDI quintiles. The significantly higher prevalence and incidence rates of AEMT among the older population in high SDI quintiles, compared to lower SDI quintiles, could be attributed to the healthcare overutilization, highlighting the need for policy adjustments.

Open radical cystectomy is the current standard treatment for bladder cancer. However, it is associated with high morbidity and mortality, particularly in the elderly. Recently, robotic surgery has become a minimally invasive approach. To this end, we aimed to evaluate the safety and complications of robot-assisted radical cystectomy (RARC) in elderly patients with urothelial carcinoma. We performed a retrospective single-center analysis of 103 patients who underwent RARC between May 2018 and May 2024. The patients were divided into an elderly group (age, &#x2265;&#x2009;80&#x2009;years; n&#x2009;=&#x2009;24) and a younger group (n&#x2009;=&#x2009;79). The American Society of Anesthesiologists Physical Status Classification System scores were significantly lower in the elderly group than in the younger group. No significant differences were observed between the two groups in terms of demography. Operative time was shorter in the elderly group than in the younger group. Conversely, the postoperative hospital stay was shorter in the younger group than in the elderly group. There were no significant differences in the frequency or severity of complications between the two groups; however, the incidence of ileus was significantly higher in the elderly group. In addition, higher age, ileus, and days to drain removal were identified as independent factors that prolonged hospitalization. RARC is a safe treatment option for elderly patients with bladder cancer, with complication profiles comparable to those in younger patients. However, the increased risk of ileus and prolonged hospitalization in elderly patients highlights the need for cautious perioperative management to optimize outcomes in this growing population.

To explore a functional anteroposterior pelvis diameter (APD) cutoff for diagnosing hydronephrosis (HDN) in the pediatric population, and to evaluate the correlation between structural and functional renal parenchymal thickness (PT) measured by ultrasonography (US) and technetium-99m dimercaptosuccinic acid single-photon emission CT (99mTc-DMSA SPECT), respectively. This single-center cohort study enrolled 76 pediatric patients (152 kidney units) referred to the Department of Nuclear Medicine of Children's Medical Center. Structural and functional PT were measured by US and 99mTc-DMSA SPECT, respectively. The 99mTc-DMSA SPECT was assessed by a pediatric nuclear medicine specialist blinded to the US findings. The 99mTc-DMSA SPECT and US were performed on the same day. The correlation between structural and functional PT measurements was evaluated through the Spearman correlation analysis while the functional APD cutoff for HDN diagnosis was established by using the receiver operating characteristic curve. The study demonstrated a poor to moderate relationship between structural and functional PT (Spearman's rho=0.30-0.52, p<0.05). A functional APD cutoff of 14 mm in the 99mTc-DMSA SPECT was in concordance with the ultrasonographic cutoff of 10 mm for diagnosing HDN. This study can give the experts new insights into using the 99mTc-DMSA SPECT as an additional modality in measuring the functional renal dimensions, especially PT alongside the US findings.

We aimed to perform a systematic review and meta-analysis to assess the efficacy of virtual reality (VR) distraction technologies in managing pain and anxiety in patients undergoing cystoscopy procedures. We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception to July 2024, for studies comparing the use of VR distraction technologies versus no VR distraction in patients undergoing cystoscopy. The primary endpoints evaluated were patient-reported anxiety and procedural pain scores, and post-procedural heart rate (HR). Standardized mean differences (SMDs) and their 95% confidence intervals (CIs) were computed with the use of a random-effects model. The statistical analysis was conducted using Review Manager 5.4. A total of 575 patients from four randomized controlled trials were included, of whom 289 (50%) underwent the cystoscopy procedure using VR distraction technologies. The mean age of all patients was 57.25 years old, and 395 (69%) of them were male. In our pooled analysis, we did not observe a statistically significant reduction in patient-reported procedural pain (SMD -0.16; 95% CI -0.32-0.00; p=0.060; I 2=0%), anxiety (SMD -0.37; 95% CI -1.65-0.90; p=0.6; I 2=93%), or post-procedural HR (SMD -0.58; 95% CI -1.62-0.45; p=0.3; I 2=97%). In this comprehensive meta-analysis comprising 575 patients who underwent cystoscopy, the use of VR was not associated with a significant difference in pain, anxiety, or HR levels.

Alternative splicing (AS) is increasingly recognized as a hallmark of cancer, contributing to tumor progression and therapeutic resistance. Zinc finger MYND-type containing 11 (ZMYND11), a critical reader of the histone modification H3.3K36me3, is frequently downregulated in various cancers. However, its specific role in regulating AS in prostate cancer (PCa) remains unclear. This study aimed to elucidate the mechanisms by which ZMYND11 modulates AS in PCa and evaluate its potential as a therapeutic target. The comprehensive AS analysis was conducted using two bioinformatics tools, SUPPA2 and rMATS, applied to data from ZMYND11 knockdown PCa cell lines and a large cohort of PCa patient samples. Candidate ZMYND11-mediated AS events were identified based on overlapping results from both tools. Experimental validation was performed in multiple PCa cell lines, and confirmed findings were classified as notable AS events. SUPPA2, with a threshold of an absolute &#x394;PSI >0.1 and p-value <0.05, was identified as the optimal tool for detecting ZMYND11-mediated AS events. A total of 19 candidate AS events were identified, with approximately 50% involving exon skipping. Experimental validation highlighted three notable AS events affecting mitogen-activated protein kinase kinase kinase kinase 4 (MAP4K4), golgin B1 (GOLGB1), and Dmx like 1 (DMXL1). These events are implicated in key pathways influencing tumor growth and metastasis, underscoring the tumor-suppressive role of ZMYND11 in PCa. This study systematically characterizes ZMYND11-mediated AS in PCa, revealing its pivotal role in modulating splicing events critical to tumor progression. The findings establish ZMYND11 as a potential biomarker and a promising source of novel therapeutic targets for PCa management.

Type 2 diabetes mellitus has previously been reported to be potentially associated with urolithiasis. We conducted a Mendelian randomization (MR) study to explore whether there is a causal relationship between genetic susceptibility to common antidiabetic drugs and urolithiasis risk. We used genetic variants from two different sources as instruments to proxy the exposure to antidiabetic drugs for our MR research design. The variants included loci regulating expression traits of the target genes, and genetic variants associated with blood glucose nearby or within antidiabetic drug target genes from genome-wide association studies. We ultimately calculated estimates using inverse-variance weighted MR (IVW-MR) and summary-data-based MR methods. The Bonferroni-corrected IVW results suggested potassium inwardly rectifying channel subfamily J member 11 (KCNJ11)-mediated blood glucose was associated with a lower risk of urolithiasis (odds ratio [OR]: 0.15; 95% confidence interval [CI]: 0.06-0.39; p=1.19&#xd7;10-4). Similarly, we also observed a higher expression of KCNJ11 was linked to a decreased risk of urolithiasis in the summary-data-based MR analysis (OR: 0.81 per 1 mmol/L decrement in blood glucose; 95% CI: 0.70-0.95; p=0.008). We found suggestive evidence of the positive relationship between insulin receptor expression and urolithiasis (OR: 5.67; 95% CI: 1.01-31.97; p=0.049), which was not supported when using cis-expression quantitative trait locus as an instrument. This study provided evidence for a potential causal link between KCNJ11-mimicked sulfonylureas and the reduced risk of urolithiasis. Given the limitations of this study, it is essential to investigate further using the latest data from large-scale genetic studies and relevant clinical data to validate our findings from the MR study.